﻿<%@ Page Language="C#" MasterPageFile="~/travel-insurance/proposalforms/TravelInsuranceProposalMasterPage.master"
    Async="true" Title="Travel Insurance - CompareXpress Singapore" AutoEventWireup="true"
    CodeFile="etiqa_proposal_form.aspx.cs" Inherits="travel_insurance_proposalforms_etiqa_proposal_form" %>

<%@ Register Src="~/controls/usrPhoneNo.ascx" TagName="usrPhoneNo" TagPrefix="uc1" %>
<%@ Register Src="~/controls/usrDate.ascx" TagName="usrDate" TagPrefix="uc2" %>
<%@ Register Src="~/controls/usrIdType.ascx" TagName="usrIdType" TagPrefix="uc3" %>
<%@ Register Src="~/controls/usrIdNumber.ascx" TagName="usrIdNumber" TagPrefix="uc4" %>
<%@ Register Src="~/controls/usrCompanyLogoByServices.ascx" TagName="usrCompanyLogoByServices"
    TagPrefix="uc5" %>
<%@ Register Src="~/controls/usrSalutation.ascx" TagName="usrSalutation" TagPrefix="uc6" %>
<%@ Register Src="~/controls/usrNationality.ascx" TagName="usrNationality" TagPrefix="uc7" %>
<%@ Register Src="~/controls/usrGender.ascx" TagName="usrGender" TagPrefix="uc8" %>
<%@ Register Src="~/controls/usrRelationship.ascx" TagName="usrRelationship" TagPrefix="uc9" %>
<%@ Register Src="~/controls/usrTraveller.ascx" TagName="usrTraveller" TagPrefix="uc10" %>
<%@ Register Src="~/controls/usrNoJS.ascx" TagName="usrNoJS" TagPrefix="ucNoJS" %>
<%@ Register Src="~/controls/usrCXAds.ascx" TagName="usrCXAds" TagPrefix="ucAds" %>
<asp:Content ID="Content1" ContentPlaceHolderID="ContentPlaceHolder1" runat="Server">
    <div id="container">
        <div id="nav_top">
            <div class="left pad_8yr">
                <asp:ImageButton ID="imgbtnBackTop" runat="server" ImageUrl="/images/forms_proposal/button/back.png"
                    OnClick="imgbtnBackTop_Click" OnClientClick="return confirm('Are you sure to go back?');" />
                <%--  <a href="/travel-insurance/taresultsquotesone.aspx" onclick="return confirm('Are you sure to go back?');">
                    <img src="/images/forms_proposal/button/back.png" alt="Back" /></a>--%>
            </div>
            <div class="right pad_8yr">
                <img src="/images/forms_proposal/nav/logo_comparexpress.png" alt="CompareXpress" /></div>
        </div>
        <ucNoJS:usrNoJS ID="usrNoJS1" runat="server" />
        <asp:ScriptManager ID="ScriptManager1" runat="server" AsyncPostBackTimeout="36000">
        </asp:ScriptManager>
        <div runat="server" id="divAgentRequest" visible="false">
            <asp:Label ID="lblTAId" runat="server" />
            <asp:Label ID="lblCustomerId" runat="server" />
            <asp:Label ID="lblCarResultId" runat="server" />
            <asp:Label ID="lblProviderCompanyId" runat="server" />
            <asp:Label ID="lblCarMoreDetailId" runat="server" />
            <asp:Label ID="lblCustomerGivenName" runat="server" />
            <asp:Label ID="lblCustomerMobileNo" runat="server" />
        </div>
        <!-- #Include file="/includes/body_loader.inc" -->
        <div id="divContent" style="display: none;">
            <div id="contentBody">
                <div id="header">
                    <div class="seperator">
                    </div>
                    <div class="right" style="width: 240px">
                        <div class="quotesum_button">
                            <img src="/images/forms_proposal/button/quotesum.png" width="240" height="73" alt="Quote Summary" /></div>
                    </div>
                    <h1>
                        Online Travel Insurance Proposal Form -
                        <asp:Label ID="lblProvider" runat="server"></asp:Label></h1>
                    <div class="seperator">
                    </div>
                    <div class="quotesum">
                        <div class="top">
                        </div>
                        <div id="divQuoteSummery" class="body pad_15x">
                            <!-- QUOTE SUMMARY | Start -->
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Quote Reference Number</h1>
                                <p>
                                    <asp:Label ID="lblQref" runat="server"></asp:Label></p>
                                <h1>
                                    Type of Travel:</h1>
                                <p>
                                    <asp:Label ID="lblCoverageType" runat="server"></asp:Label><asp:Label ID="lblCover"
                                        runat="server" Visible="false"></asp:Label><asp:Label ID="lblCoverage" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                            </div>
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Country Traveling to (one or furthest):</h1>
                                <p>
                                    <asp:Label ID="lblDestination" runat="server"></asp:Label><asp:Label ID="lblTrip"
                                        runat="server" Visible="false"></asp:Label></p>
                                <h1>
                                    Period of Insurance:</h1>
                                <p>
                                    <asp:Label ID="lblPeriodOfCoverage" runat="server"></asp:Label>
                                    <asp:Label ID="lblDuration" runat="server" Visible="false"></asp:Label><asp:Label
                                        ID="lblStart" runat="server" Visible="false"></asp:Label><asp:Label ID="lblEnd" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                            </div>
                            <div class="w21per left pad_25xr">
                                <h1>
                                    Type of Plan:</h1>
                                <p>
                                    <asp:Label ID="lblPolicyType" runat="server"></asp:Label><asp:Label ID="lblAdultAge"
                                        runat="server" Visible="false"></asp:Label><asp:Label ID="lblChildAge" runat="server"
                                            Visible="false"></asp:Label>
                                </p>
                                <h1>
                                    No. of Traveller/s:</h1>
                                <p>
                                    <asp:Label ID="lblNoOfTravellers" runat="server"></asp:Label><input id="inNoOfTravellers"
                                        runat="server" type="hidden" />
                                    <input id="inPlanName" runat="server" type="hidden" /><input id="inTripType" runat="server"
                                        type="hidden" />
                                    <input id="inAreaId" runat="server" type="hidden" /><input id="inCountryId" runat="server"
                                        type="hidden" />
                                    <input id="inInsuredType" runat="server" type="hidden" />
                                </p>
                            </div>

                            <script type="text/javascript">
                                IncreaseProgress(20);
                            </script>

                            <div class="w21per left pad_25xr">
                                <h1>
                                    &nbsp;</h1>
                                <p>
                                    &nbsp;</p>
                                <h1>
                                    Total Premium (w/ GST):</h1>
                                <p>
                                    $
                                    <asp:Label ID="lblTotalPremium" runat="server"></asp:Label></p>
                            </div>
                            <!-- QUOTE SUMMARY | End   -->
                        </div>
                        <div class="bottom">
                        </div>
                    </div>
                </div>
                <div class="seperator">
                </div>

                <script type="text/javascript">
                    IncreaseProgress(25);
                </script>

                <div id="body">
                </div>
                <div id="divValidationSummary">
                    <asp:ValidationSummary ID="vstravelinsurance" runat="server" CssClass="errorSummary"
                        ValidationGroup="travel_insurance" HeaderText="Oops please complete the form" />
                </div>
                <div class="form">
                    <div class="top">
                        <div class="left">
                            <div class="pad_10t pad_35xl white">
                                Online Travel Insurance Proposal Form</div>
                        </div>
                        <div class="right">
                        </div>
                    </div>
                    <div class="body">
                        <div class="inner">
                            <div class="pad_20x10y">
                                <div class="norm">
                                    <div class="top_t">
                                    </div>
                                    <div class="body">
                                        <div class="pad_15x">
                                            <h1>
                                                Important Notice</h1>
                                            <p>
                                                Statement pursuant to Section 25(5) of The Insurance Act (CAP 142) (or any subsequent
                                                amendments thereof). You are to disclose in this Application, fully and faithfully
                                                all the facts which you know or ought to know in respect of the risk that is being
                                                proposed. You are currently in good health, free from physical impairment and deformity
                                                otherwise, the Policy insured may be void.
                                            </p>
                                            <br />
                                            <p>
                                                <b>Policy Owners’ Protection Scheme</b>
                                                <br />
                                                This policy is protected under the Policy Owners’ Protection Scheme which is administered
                                                by the Singapore Deposit Insurance Corporation (SDIC). Coverage for your policy
                                                is automatic and no further action is required from you. For more information on
                                                the types of benefits that are covered under the scheme as well as the limits of
                                                coverage, where applicable, please contact your insurer or visit the GIA / LIA or
                                                SDIC websites (<a href='http://www.gia.org.sg' target='_blank'>www.gia.org.sg</a>
                                                or <a href='http://www.lia.org.sg' target='_blank'>www.lia.org.sg</a> or <a href='http://www.sdic.org.sg'
                                                    target='_blank'>www.sdic.org.sg</a>).
                                            </p>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>
                                <div class="hilite">
                                    <div class="top">
                                    </div>
                                    <div class="body_in pad_15x">
                                        <h1>
                                            Customer Personal Details</h1>
                                        <div class="seperator">
                                        </div>
                                        <div class="w43per left">
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Salutation:</div>
                                                <div class="left">
                                                    <uc6:usrSalutation ID="ddlSalutation" runat="server" ValidationGroup="travel_insurance" />
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Surname:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtSurname" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvSurname" runat="server" ControlToValidate="txtSurname"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Given/First Name:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtFirstname" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:HyperLink ID="hplEditProfile" Visible="false" NavigateUrl="~/user/editprofile.aspx?redir=~/travel-insurance/applicants_details.aspx"
                                                        Font-Size="Smaller" Text="Edit Profile" runat="server"></asp:HyperLink>
                                                    <asp:RequiredFieldValidator ID="rfvFirstname" runat="server" ControlToValidate="txtFirstname"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> E-mail:</div>
                                                <div class="left">
                                                    <asp:TextBox ID="txtEmailAddress" runat="server" Width="200px"></asp:TextBox>
                                                    <asp:RequiredFieldValidator ID="rfvEmailAddress" runat="server" ControlToValidate="txtEmailAddress"
                                                        Display="Dynamic" CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    <asp:RegularExpressionValidator ID="revEmailAddress" runat="server" ControlToValidate="txtEmailAddress"
                                                        CssClass="validationErrorControl" ErrorMessage="" ValidationExpression="\w+([-+.']\w+)*@\w+([-.]\w+)*\.\w+([-.]\w+)*"
                                                        ValidationGroup="travel_insurance"></asp:RegularExpressionValidator>
                                                </div>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Nationality:</div>
                                                <div class="left">
                                                    <uc7:usrNationality ID="ddlNationality" runat="server" ErrorMessage="" ValidationGroup="travel_insurance" />
                                                </div>
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> NRIC:</div>
                                                <div class="left">
                                                    <uc4:usrIdNumber ID="ddlNRICPolicyHolder" runat="server" ValidationGroup="travel_insurance" />
                                                </div>
                                            </div>
                                        </div>
                                        <div class="w56per left">
                                           <%-- <asp:UpdatePanel ID="UpdatePanel1" runat="server">
                                                <ContentTemplate>--%>
                                                    <div id="divPostCode">
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Postcode:
                                                        </div>
                                                        <asp:TextBox ID="txtPostCode" size="8" onkeypress="restrictToNumbers(event)" runat="server" MaxLength="6" Width="80px"></asp:TextBox>
                                                       <%-- <asp:ImageButton ID="ibtPostCode" runat="server" CssClass="button" align="absmiddle"
                                                            OnClick="ibtPostCode_Click" Width="108" ValidationGroup="PostCode" AlternateText="Get Address"
                                                            ImageUrl="~/images/forms_proposal/button/getaddress.png" />
                                                        <asp:UpdateProgress runat="server" ID="uplUpProgress" DisplayAfter="500">
                                                            <ProgressTemplate>
                                                                <span style="position: absolute; text-align: right; width: 390px;">
                                                                    <img src="../../images/loading7.gif" id="ldPostCode" alt="loading" />
                                                                </span>
                                                            </ProgressTemplate>
                                                        </asp:UpdateProgress>--%>
                                                        <asp:RequiredFieldValidator ID="rfvPCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="PostCode" ControlToValidate="txtPostCode"></asp:RequiredFieldValidator>
                                                        <asp:RegularExpressionValidator ID="revPCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="PostCode" ValidationExpression="[0-9]{6}"
                                                            ControlToValidate="txtPostCode"></asp:RegularExpressionValidator>
                                                        <asp:RequiredFieldValidator ID="rfvPostCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtPostCode"></asp:RequiredFieldValidator>
                                                        <asp:RegularExpressionValidator ID="revPostCode" runat="server" CssClass="validationErrorControl"
                                                            Display="Dynamic" ErrorMessage="" ValidationGroup="travel_insurance" ValidationExpression="[0-9]{6}"
                                                            ControlToValidate="txtPostCode"></asp:RegularExpressionValidator>
                                                    </div>
                                                    <div runat="server" visible="false" id="divAddressList">
                                                        <div class="h10">
                                                        </div>
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            Please choose your address
                                                        </div>
                                                        <asp:DropDownList ID="ddlAddressList" Width="320px" AutoPostBack="true" runat="server"
                                                            OnSelectedIndexChanged="ddlAddressList_SelectedIndexChanged">
                                                        </asp:DropDownList>
                                                    </div>
                                                <%--</ContentTemplate>
                                            </asp:UpdatePanel>--%>
                                            <div class="h10">
                                            </div>
                                            <div id="divUnitNo">
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Unit Number:
                                                </div>
                                                <asp:TextBox ID="txtUnit1" MaxLength="10" runat="server" size="8"></asp:TextBox>-
                                                <asp:RequiredFieldValidator ID="rfvUnit1" runat="server" CssClass="validationErrorControl"
                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtUnit1"></asp:RequiredFieldValidator>
                                                <asp:TextBox ID="txtUnit2" MaxLength="10" runat="server" size="8"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="rfvUnit2" runat="server" CssClass="validationErrorControl"
                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtUnit2"></asp:RequiredFieldValidator>
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <asp:UpdatePanel ID="UpdatePanel2" runat="server">
                                                <ContentTemplate>
                                                    <div id="divPCAddress">
                                                        <div class="w180 left align_right pad_6t pad_7xr">
                                                            <span class="red">*</span> Address:
                                                        </div>
                                                        <span id="divAddress"></span>
                                                        <asp:TextBox ID="txtAddress" runat="server" TextMode="MultiLine" MaxLength="120"
                                                            Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvAddress" runat="server" CssClass="validationErrorControl"
                                                            ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtAddress"></asp:RequiredFieldValidator>
                                                    </div>
                                                </ContentTemplate>
                                            </asp:UpdatePanel>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Date of Birth:
                                                </div>
                                                <uc2:usrDate ID="usrDOBPolicyHolder" runat="server" ValidationGroup="travel_insurance"
                                                    IsRequired="True" />
                                            </div>
                                            <div class="h10">
                                            </div>
                                            <div>
                                                <div class="w180 left align_right pad_6t pad_7xr">
                                                    <span class="red">*</span> Gender:
                                                </div>
                                                <uc8:usrGender ID="usrGenderPolicyHolder" runat="server" ValidationGroup="travel_insurance" />
                                            </div>
                                        </div>
                                        <div class="clear">
                                        </div>
                                        <div class="h10">
                                        </div>
                                        <div style="border: 1px solid #ccc; width: 912px; background: #d2d2d2;">
                                            <div class="h10">
                                            </div>
                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                Contact Info:</div>
                                            <div class="w190 note left">
                                                <span class="red">*</span> Mobile Number<br />
                                                <uc1:usrPhoneNo ID="txtMobileNo" IsEnabled="true" IsRequired="true" PhoneNoRequireErrorMessage="Require mobile number."
                                                    PhoneNoErrorMessage="Mobile phone number should 8 digits." PhoneNoValidErrorMessage="Invalid mobile phone number."
                                                    runat="server" ValidationGroup="travel_insurance" />
                                            </div>
                                            <div class="w190 note left">
                                                Home Phone Number<br />
                                                <uc1:usrPhoneNo ID="txtResidentialPhoneNo" runat="server" ValidationGroup="travel_insurance"
                                                    IsRequired="False" PhoneNoValidErrorMessage="Invalid home phone number." />
                                            </div>
                                            <div class="w190 note left">
                                                Office Phone Number<br />
                                                <uc1:usrPhoneNo ID="txtOfficeNo" runat="server" ValidationGroup="travel_insurance"
                                                    IsRequired="False" />
                                            </div>
                                            <div class="h10">
                                            </div>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>

                                <script type="text/javascript">
                                    IncreaseProgress(40);
                                </script>

                                <div class="hilite" id="divTravellersInsured">
                                    <div class="top">
                                    </div>
                                    <div class="body_in pad_15x" id="divInsured">
                                        <h1>
                                            Insured Details</h1>
                                        <div class="seperator">
                                        </div>
                                        <div id="divIndividual" runat="server">
                                            <div class="w43per left">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <asp:CheckBox ID="chkIndividualInsurerNameSame" runat="server" Text="" onclick="CheckedChangedIndividual();" />
                                                    </div>
                                                    <div>
                                                        <span><b>Proposer Details same as Insured Details.</b></span>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Surname:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNameOfInsured" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNameOfInsured" runat="server" ControlToValidate="txtNameOfInsured"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Given:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNameOfInsuredGiven" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNameOfInsuredGiven" runat="server" ControlToValidate="txtNameOfInsuredGiven"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <uc2:usrDate ID="usrDOB" runat="server" ValidationGroup="travel_insurance" IsRequired="True" />
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Gender:
                                                    </div>
                                                    <uc8:usrGender ID="usrGender" runat="server" ValidationGroup="travel_insurance" />
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC:</div>
                                                    <div class="left">
                                                        <uc4:usrIdNumber ID="ddlNRIC" runat="server" ValidationGroup="travel_insurance" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Relationship to Policy Holder:</div>
                                                    <div class="left">
                                                        <asp:DropDownList runat="server" ID="ddlRelationship">
                                                            <asp:ListItem Selected="True" Value="Myself">Myself</asp:ListItem>
                                                            <asp:ListItem Value="Spouse">Spouse</asp:ListItem>
                                                            <asp:ListItem Value="Son/Daughter">Son/Daughter</asp:ListItem>
                                                            <asp:ListItem Value="Brother/Sister">Brother/Sister</asp:ListItem>
                                                            <asp:ListItem Value="Mother/Father">Mother/Father</asp:ListItem>
                                                            <asp:ListItem Value="Extended Relative">Extended Relative</asp:ListItem>
                                                            <asp:ListItem Value="Friend">Friend</asp:ListItem>
                                                            <asp:ListItem Value="Other">Other</asp:ListItem>
                                                        </asp:DropDownList>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div style="display: none;" id="divNoOfChild" runat="server">
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Number of children travelling:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtNoOfChild" runat="server" Width="200px" Text="0"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvNoOfChild" runat="server" ControlToValidate="txtNoOfChild"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                        <asp:TextBox ID="txtNoOfAdult" runat="server" Width="200px" Text="0"></asp:TextBox>
                                                        <asp:TextBox ID="txtNoOfTravellers" runat="server" Width="200px" Text="0"></asp:TextBox>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <div id="divWithspouse" runat="server">
                                            <div class="w43per left">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <asp:CheckBox ID="chkWithSpouseInsurerSame" runat="server" Text="" onclick="CheckedChangedWithSpouse();" />
                                                    </div>
                                                    <div class="left">
                                                        <span><b>Proposer Details same
                                                            <br />
                                                            as Insured Details.</b></span>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Surname:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtInsured" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvInsured" runat="server" ControlToValidate="txtInsured"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Given Name:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtInsuredGiven" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvInsuredGiven" runat="server" ControlToValidate="txtInsuredGiven"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <div class="left">
                                                        <uc2:usrDate ID="usrDOBinsured" runat="server" ValidationGroup="travel_insurance"
                                                            IsRequired="True" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Gender:
                                                    </div>
                                                    <uc8:usrGender ID="usrGenderInsured" runat="server" ValidationGroup="travel_insurance" />
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC:</div>
                                                    <div class="left">
                                                        <uc4:usrIdNumber ID="ddlNRICInsured" runat="server" ValidationGroup="travel_insurance" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Relationship to Policy Holder:</div>
                                                    <div class="left">
                                                        <asp:DropDownList runat="server" ID="ddlRelationshipWithSpouse">
                                                            <asp:ListItem Selected="True" Value="Myself">Myself</asp:ListItem>
                                                            <asp:ListItem Value="Spouse">Spouse</asp:ListItem>
                                                            <asp:ListItem Value="Son/Daughter">Son/Daughter</asp:ListItem>
                                                            <asp:ListItem Value="Brother/Sister">Brother/Sister</asp:ListItem>
                                                            <asp:ListItem Value="Mother/Father">Mother/Father</asp:ListItem>
                                                            <asp:ListItem Value="Extended Relative">Extended Relative</asp:ListItem>
                                                            <asp:ListItem Value="Friend">Friend</asp:ListItem>
                                                            <asp:ListItem Value="Other">Other</asp:ListItem>
                                                        </asp:DropDownList>
                                                    </div>
                                                </div>
                                            </div>
                                            <div class="w56per left">
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Name of Spouse (Surname):</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtSpouse" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvSpouse" runat="server" ControlToValidate="txtSpouse"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Given Name:</div>
                                                    <div class="left">
                                                        <asp:TextBox ID="txtSpouseGiven" runat="server" Width="200px"></asp:TextBox>
                                                        <asp:RequiredFieldValidator ID="rfvSpouseGiven" runat="server" ControlToValidate="txtSpouseGiven"
                                                            CssClass="validationErrorControl" ErrorMessage="" ValidationGroup="travel_insurance"></asp:RequiredFieldValidator>
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Date of Birth:</div>
                                                    <div class="left">
                                                        <uc2:usrDate ID="usrDOBSpouse" runat="server" ValidationGroup="travel_insurance"
                                                            IsRequired="True" />
                                                    </div>
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> Gender:
                                                    </div>
                                                    <uc8:usrGender ID="usrGenderSpouse" runat="server" ValidationGroup="travel_insurance" />
                                                </div>
                                                <div class="h10">
                                                </div>
                                                <div>
                                                    <div class="w180 left align_right pad_6t pad_7xr">
                                                        <span class="red">*</span> NRIC:</div>
                                                    <div class="left">
                                                        <uc4:usrIdNumber ID="ddlNRICSpouse" runat="server" ValidationGroup="travel_insurance" />
                                                    </div>
                                                </div>
                                                <%-- <div style="display: none;">
                                                    <div>
                                                        <asp:TextBox ID="txtNRICwidSpouse" runat="server" Text="Valid"></asp:TextBox>
                                                        <asp:CustomValidator CssClass="validationErrorControl" ControlToValidate="txtNRICwidSpouse"
                                                            ValidationGroup="travel_insurance" ID="csvNRIC" ClientValidationFunction="Check2NRICValid"
                                                            OnServerValidate="Check2NRICValid" runat="server" ErrorMessage="Applicant IC/Passport and Spouse IC/Passport is the same."
                                                            Text=""></asp:CustomValidator>
                                                    </div>
                                                </div>--%>
                                            </div>
                                        </div>
                                        <div class="clear">
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>
                                </div>
                                <div class="seperator">
                                </div>

                                <script type="text/javascript">
                                    IncreaseProgress(50);
                                </script>

                                <asp:Panel ID="pnlChildsParticulars" runat="server" Width="100%">
                                    <div class="hilite" id="divChilds">
                                        <div class="top">
                                        </div>
                                        <div class="body_in pad_15x">
                                            <h1>
                                                Child's Details</h1>
                                            <asp:Panel ID="pnlChild1" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 1</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName1">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Surname:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName1" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName1" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName1"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName1" runat="server" ControlToValidate="txtChildName1"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Given Name:</div>
                                                            <div class="left">
                                                                <asp:TextBox ID="txtChildName1Given" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName1Given" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName1Given"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName1Given" runat="server" ControlToValidate="txtChildName1Given"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber1" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB1" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:
                                                            </div>
                                                            <uc8:usrGender ID="usrGenderChild1" runat="server" ValidationGroup="travel_insurance"
                                                                IsEnabled="false" />
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild2" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 2</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName2">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Surname:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName2" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName2" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName2"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName2" runat="server" ControlToValidate="txtChildName2"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Given Name:</div>
                                                            <div class="left">
                                                                <asp:TextBox ID="txtChildName2Given" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName2Given" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName2Given"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName2Given" runat="server" ControlToValidate="txtChildName2Given"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber2" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB2" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:
                                                            </div>
                                                            <uc8:usrGender ID="usrGenderChild2" runat="server" ValidationGroup="travel_insurance"
                                                                IsEnabled="false" />
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild3" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 3</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName3">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Surname:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName3" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName3" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName3"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName3" runat="server" ControlToValidate="txtChildName3"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Given Name:</div>
                                                            <div class="left">
                                                                <asp:TextBox ID="txtChildName3Given" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName3Given" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName3Given"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName3Given" runat="server" ControlToValidate="txtChildName3Given"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber3" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB3" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:
                                                            </div>
                                                            <uc8:usrGender ID="usrGenderChild3" runat="server" ValidationGroup="travel_insurance"
                                                                IsEnabled="false" />
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>

                                            <script type="text/javascript">
                                                IncreaseProgress(60);
                                            </script>

                                            <asp:Panel ID="pnlChild4" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 4</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName4">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Surname:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName4" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName4" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName4"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName4" runat="server" ControlToValidate="txtChildName4"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Given Name:</div>
                                                            <div class="left">
                                                                <asp:TextBox ID="txtChildName4Given" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName4Given" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName4Given"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName4Given" runat="server" ControlToValidate="txtChildName4Given"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber4" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB4" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:
                                                            </div>
                                                            <uc8:usrGender ID="usrGenderChild4" runat="server" ValidationGroup="travel_insurance"
                                                                IsEnabled="false" />
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild5" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 5</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName5">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Surname:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName5" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName5" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName5"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName5" runat="server" ControlToValidate="txtChildName5"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Given Name:</div>
                                                            <div class="left">
                                                                <asp:TextBox ID="txtChildName5Given" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName5Given" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName5Given"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName5Given" runat="server" ControlToValidate="txtChildName5Given"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber5" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB5" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:
                                                            </div>
                                                            <uc8:usrGender ID="usrGenderChild5" runat="server" ValidationGroup="travel_insurance"
                                                                IsEnabled="false" />
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                            <asp:Panel ID="pnlChild6" runat="server" Width="100%">
                                                <div class="seperator">
                                                </div>
                                                <div>
                                                    <h3>
                                                        Child 6</h3>
                                                    <div class="h10">
                                                    </div>
                                                    <div class="w43per left">
                                                        <div id="divChildName6">
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Surname:</div>
                                                            <div class="left pad_6t">
                                                                <asp:TextBox ID="txtChildName6" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName6" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName6"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName6" runat="server" ControlToValidate="txtChildName6"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Given Name:</div>
                                                            <div class="left">
                                                                <asp:TextBox ID="txtChildName6Given" MaxLength="50" runat="server" Width="200px"></asp:TextBox>
                                                                <asp:RequiredFieldValidator ID="rfvChildName6Given" runat="server" CssClass="validationErrorControl"
                                                                    ErrorMessage="" ValidationGroup="travel_insurance" ControlToValidate="txtChildName6Given"></asp:RequiredFieldValidator>
                                                                <asp:RegularExpressionValidator ID="revChildName6Given" runat="server" ControlToValidate="txtChildName6Given"
                                                                    ValidationExpression="^[a-zA-Z''-'\s]{1,50}$" ValidationGroup="travel_insurance"
                                                                    CssClass="validationErrorControl" Text="" ErrorMessage=""></asp:RegularExpressionValidator>
                                                            </div>
                                                        </div>
                                                    </div>
                                                    <div class="w56per left">
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> NRIC Number:</div>
                                                            <div class="left">
                                                                <uc4:usrIdNumber ID="ddlChildIdNumber6" runat="server" ValidationGroup="travel_insurance" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Date of Birth:</div>
                                                            <div class="left">
                                                                <uc2:usrDate ID="ddlChildDOB6" runat="server" ValidationGroup="travel_insurance"
                                                                    IsEnabled="false" />
                                                            </div>
                                                        </div>
                                                        <div class="h10">
                                                        </div>
                                                        <div>
                                                            <div class="w180 left align_right pad_6t pad_7xr">
                                                                <span class="red">*</span> Gender:
                                                            </div>
                                                            <uc8:usrGender ID="usrGenderChild6" runat="server" ValidationGroup="travel_insurance"
                                                                IsEnabled="false" />
                                                        </div>
                                                        <div class="clear">
                                                        </div>
                                                    </div>
                                                </div>
                                            </asp:Panel>
                                        </div>
                                        <div class="bottom">
                                        </div>
                                    </div>
                                    <div class="seperator">
                                    </div>
                                </asp:Panel>

                                <script type="text/javascript">
                                    IncreaseProgress(70);
                                </script>

                                <div class="seperator">
                                </div>

                                <script type="text/javascript">
                                    IncreaseProgress(80);
                                </script>

                                <div class="norm" id="divDeclarationHeader">
                                    <div class="top">
                                    </div>
                                    <div class="body">
                                        <div class="pad_15x">
                                            <h1>
                                                Warranty and Declaration</h1>
                                            <div class="seperator">
                                            </div>
                                            <div>
                                                <p>
                                                    I/We, the insured person(s) warrant that I/We am/are not travelling contrary to
                                                    the advice of a Medical Practitioner or for the purpose of obtaining medical treatment.
                                                </p>
                                                <div class="h7">
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="bottom">
                                    </div>

                                    <script type="text/javascript">
                                        IncreaseProgress(90);
                                    </script>

                                </div>
                                <div class="center align_center" id="divFormButtons">
                                    <asp:UpdatePanel runat="server" ID="upanelSubmit">
                                        <ContentTemplate>
                                            <asp:UpdateProgress ID="UpdateProgressSubmit" runat="server">
                                                <ProgressTemplate>
                                                    <div id="divLoading" style="text-align: center; width: 920px; height: 120px; position: absolute;">
                                                        <table width="100%">
                                                            <tr>
                                                                <td align="center" valign="bottom">
                                                                    <img src="../../images/loader/loader_apple.gif" alt="Loading" align="absmiddle" />
                                                                    <span id="Span1"><b>Please wait...</b></span><span id="Span2"></span>
                                                                </td>
                                                            </tr>
                                                        </table>
                                                    </div>
                                                </ProgressTemplate>
                                            </asp:UpdateProgress>
                                            <div class="seperator">
                                            </div>
                                            <div class="h7">
                                            </div>
                                            <asp:ImageButton ID="ibtSubmit" runat="server" ValidationGroup="travel_insurance"
                                                OnClientClick="LoadValidationErrorCss();" ImageUrl="~/images/forms_proposal/button/submit.png"
                                                OnClick="ibtSubmit_Click" class="button" /><br />
                                            <asp:Label ID="lblMessage" runat="server" ForeColor="Red" Font-Bold="true"></asp:Label>
                                        </ContentTemplate>
                                    </asp:UpdatePanel>
                                    <div class="note">
                                        <img src="/images/forms_proposal/icon/warning.png" width="21" height="18" alt="Note"
                                            style="vertical-align: middle; padding-bottom: 3px" />
                                        <strong>Note</strong>, by clicking on the SUBMIT button you agree to our Website's
                                        <a href="../../terms/terms.aspx" target="_blank">Terms &amp; Conditions</a>
                                    </div>
                                </div>
                            </div>
                        </div>
                        <div class="bottom">
                        </div>
                    </div>
                </div>
                <div class="seperator">
                </div>
            </div>
        </div>
    </div>
    <div id="footer">
        <div id="nav_bottom" class="pad_7t">
            <div class="left pad_8yr">
                <asp:ImageButton ID="ImageButton1" runat="server" ImageUrl="/images/forms_proposal/button/back.png"
                    OnClick="imgbtnBackTop_Click" OnClientClick="return confirm('Are you sure to go back?');" />
            </div>
            <div class="right pad_8yr">
                <a href="#" onclick="window.print()">
                    <img src="/images/forms_proposal/button/print.png" alt="Print" /></a>
            </div>
        </div>
    </div>

    <script type="text/javascript">
        //<![CDATA[
        IncreaseProgress(100);
        HideLoading();
        //]]--> 
    </script>

    <script type="text/javascript">

        function ShowHideDiv(divName, varOnOff) {
            if (varOnOff) {
                document.getElementById(divName).style.display = "";
            }
            else {
                document.getElementById(divName).style.display = "none";
            }
        }


        function CheckValidationCss(divYes, divNo, ctrlText, valCtrl) {
            ShowValidationEffectOption(divYes, divNo, ctrlText, valCtrl);
            return true;
        }

        function CheckValidationCssThree(div1, div2, div3, ctrlText, valCtrl) {
            ShowValidationEffectOptionThree(div1, div2, div3, ctrlText, valCtrl);
            return true;
        }

        function CheckValidationCssFive(div1, div2, div3, div4, div5, ctrlText, valCtrl) {
            ShowValidationEffectOptionFive(div1, div2, div3, div4, div5, ctrlText, valCtrl);
            return true;
        }



        function showhide(el) {

            el = document.getElementById(el);
            el.style.display = (el.style.display == "none") ? "block" : "none";

        }

        function restrictToNumbers(e) {
            if ([e.keyCode || e.which] == 8 || [e.keyCode || e.which] == 37 || [e.keyCode || e.which] == 9 || [e.keyCode || e.which] == 39) //this is to allow backspace
                return true;

            if ([e.keyCode || e.which] < 48 || [e.keyCode || e.which] > 57)
                e.preventDefault ? e.preventDefault() : e.returnValue = false;
        }

        function requestByPostCode() {
            try {
                var _pcode = document.getElementById('<%=txtPostCode.ClientID%>').value;
                if (_pcode.length != 6) {
                    alert('Postal code length must be 6 numbers value.');
                    document.getElementById('<%=txtAddress.ClientID%>').value = '';
                    return false;
                }
                else {
                    requestData(_pcode);
                }
            }
            catch (e) {
                alert(e.toString());
            }
        }

        function set_data(json) {
            try {
                var srcTable = $("#divAddress").empty();
                var txtAddress = document.getElementById('<%=txtAddress.ClientID%>');
                if (json == null) {
                    $("<table><tr><td>No address found!</td></tr></table>").appendTo(srcTable);
                    alert("No address found!");
                    document.getElementById('<%=txtPostCode.ClientID%>').value = "";
                    txtAddress.value = "No Address found.";
                    return;
                }
                if (json.length == 0) {
                    $("<table><tr><td>No address found!</td></tr></table>").appendTo(srcTable);
                    alert("No address found!");
                    document.getElementById('<%=txtPostCode.ClientID%>').value = "";
                    txtAddress.value = "No Address found.";
                    return;
                }

                var tbl = $("<table width='50%'>");

                var tbody = $("<tbody>");
                var no = 1;
                for (var i = 0; i < json.length; i++) {
                    var trow = $("<tr>"), rec = json[i];
                    if (rec.t != null) {

                        var ctn = rec.t + "<br>" + rec.a;

                        //$("<td>").text(no).data("col", 1).appendTo(trow);
                        $("<td>").html(ctn).data("col", 2).appendTo(trow);
                        if (i == 0) {
                            txtAddress.value = rec.t + "\n" + rec.a;
                        }
                        else {
                            txtAddress.value += "\n\n" + rec.t + "\n" + rec.a;
                        }
                        no++;
                    }
                    trow.appendTo(tbody);
                }
                tbody.appendTo(tbl);
                //alert(srcTable);
                tbl.appendTo(srcTable);
            }
            catch (e) {
                alert(e.toString());
            }
        }

        function PostCodeChange() {
            document.getElementById('divAddress').innerHTML = "Your postcode changed.";
            document.getElementById('divAddress').style.display = 'none';
            document.getElementById('<%=txtAddress.ClientID%>').innerHTML = "Your postcode changed.";
        }



        function CheckedChangedWithSpouse() {
            var ctrlY = document.getElementById('<%=chkWithSpouseInsurerSame.ClientID%>');
            if (ctrlY.checked == true) {
                document.getElementById('<%=txtInsured.ClientID%>').value = document.getElementById('<%=txtSurname.ClientID%>').value;
                document.getElementById('<%=txtInsuredGiven.ClientID%>').value = document.getElementById('<%=txtFirstname.ClientID%>').value;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_ddlIdPrefix").value = document.getElementById('<%=ddlNRICPolicyHolder.ClientID%>' + "_ddlIdPrefix").value;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_txtIdNumber").value = document.getElementById('<%=ddlNRICPolicyHolder.ClientID%>' + "_txtIdNumber").value;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_ddlIdPostfix").value = document.getElementById('<%=ddlNRICPolicyHolder.ClientID%>' + "_ddlIdPostfix").value;
                document.getElementById('<%=usrGenderInsured.ClientID%>' + "_ddlGender").value = document.getElementById('<%=usrGenderPolicyHolder.ClientID%>' + "_ddlGender").value;

                document.getElementById('<%=txtInsured.ClientID%>').disabled = true;
                document.getElementById('<%=txtInsuredGiven.ClientID%>').disabled = true;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_ddlIdPrefix").disabled = true;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_txtIdNumber").disabled = true;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_ddlIdPostfix").disabled = true;
                document.getElementById('<%=ddlRelationshipWithSpouse.ClientID%>').disabled = true;
                document.getElementById('<%=ddlRelationshipWithSpouse.ClientID%>').value = 'Myself';
                document.getElementById('<%=usrGenderInsured.ClientID%>' + "_ddlGender").disabled = true;
            }
            else {

                document.getElementById('<%=txtInsured.ClientID%>').disabled = false;
                document.getElementById('<%=txtInsuredGiven.ClientID%>').disabled = false;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_ddlIdPrefix").disabled = false;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_txtIdNumber").disabled = false;
                document.getElementById('<%=ddlNRICInsured.ClientID%>' + "_ddlIdPostfix").disabled = false;
                document.getElementById('<%=ddlRelationshipWithSpouse.ClientID%>').disabled = false;
                document.getElementById('<%=usrGenderInsured.ClientID%>' + "_ddlGender").disabled = false;

            }
        }

        function CheckedChangedIndividual() {
            var ctrlY = document.getElementById('<%=chkIndividualInsurerNameSame.ClientID%>');
            if (ctrlY.checked == true) {
                document.getElementById('<%=txtNameOfInsured.ClientID%>').value = document.getElementById('<%=txtSurname.ClientID%>').value;
                document.getElementById('<%=txtNameOfInsuredGiven.ClientID%>').value = document.getElementById('<%=txtFirstname.ClientID%>').value;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_ddlIdPrefix").value = document.getElementById('<%=ddlNRICPolicyHolder.ClientID%>' + "_ddlIdPrefix").value;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_txtIdNumber").value = document.getElementById('<%=ddlNRICPolicyHolder.ClientID%>' + "_txtIdNumber").value;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_ddlIdPostfix").value = document.getElementById('<%=ddlNRICPolicyHolder.ClientID%>' + "_ddlIdPostfix").value;
                document.getElementById('<%=usrGender.ClientID%>' + "_ddlGender").value = document.getElementById('<%=usrGenderPolicyHolder.ClientID%>' + "_ddlGender").value;

                document.getElementById('<%=txtNameOfInsured.ClientID%>').disabled = true;
                document.getElementById('<%=txtNameOfInsuredGiven.ClientID%>').disabled = true;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_ddlIdPrefix").disabled = true;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_txtIdNumber").disabled = true;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_ddlIdPostfix").disabled = true;
                document.getElementById('<%=ddlRelationship.ClientID%>').disabled = true;
                document.getElementById('<%=ddlRelationship.ClientID%>').value = 'Myself';
                document.getElementById('<%=usrGender.ClientID%>' + "_ddlGender").disabled = true;

            }
            else {

                document.getElementById('<%=txtNameOfInsured.ClientID%>').disabled = false;
                document.getElementById('<%=txtNameOfInsuredGiven.ClientID%>').disabled = false;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_ddlIdPrefix").disabled = false;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_txtIdNumber").disabled = false;
                document.getElementById('<%=ddlNRIC.ClientID%>' + "_ddlIdPostfix").disabled = false;
                document.getElementById('<%=ddlRelationship.ClientID%>').disabled = false;
                document.getElementById('<%=usrGender.ClientID%>' + "_ddlGender").disabled = false;

            }
        }

    
    </script>

    <script src="../../includes/travelinsurance/ace.proposalform.js" type="text/javascript"></script>

</asp:Content>
